Objectives In view of the problems of low efficiency and accuracy in the management and control of operating costs of public hospitals under the influence of economic globalization, this paper puts forward the research on the construction of accurate management and control system of operating costs of public hospitals under the background of new medical reform.Methods Under the background of the new health care reform, through the operation cost information of public hospitals, the organizational structure of the operation cost control of public hospitals is improved, and the organization structure of the operation cost control of public hospitals is optimized. Combined with the optimization design of the operation cost control specification of public hospitals, the accurate management and control strategy of the operation cost of public hospitals is optimized, based on the standard cost and resources of the production of public hospitals.Results By eliminating the impact of the external business environment, the standard cost of public hospital production and the standard consumption of resources are optimized and adjusted, and the standard cost of public hospital products is formulated. Finally, by improving the organizational structure of public hospital operation cost, the accurate management and control system of public hospital operation cost is realized Build. Conclusions The experimental results show that under the background of the new medical reform, the accurate management and control system of public hospital operating cost has better control performance in terms of control efficiency and accuracy.